title: Coronary artery bypass grafting: Part 2--optimizing outcomes and future prospects.
abstract: Since first introduced in the mid-1960s, coronary artery bypass grafting (CABG) has become the standard of care for patients with coronary artery disease. Surprisingly, the fundamental surgical technique itself did not change much over time. Nevertheless, outcomes after CABG have dramatically improved over the first 50 years. Randomized trials comparing percutaneous coronary intervention (PCI) to CABG have shown converging outcomes for select patient populations, providing more evidence for wider use of PCI. It is increasingly important to focus on the optimization of the short- and long-term outcomes of CABG and to reduce the level of invasiveness of this procedure. This review provides an overview on how new techniques and widespread consideration of evolving strategies have the potential to optimize outcomes after CABG. Such developments include off-pump CABG, clampless/anaortic CABG, minimally invasive CABG with or without extending to hybrid procedures, arterial revascularization, endoscopic vein harvesting, intraprocedural epiaortic scanning, graft flow assessment, and improved secondary prevention measures. In addition, this review represents a framework for future studies by summarizing the areas that need more rigorous clinical (randomized) evaluation.
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Centre, PO Box 2040, 3000 CA  Rotterdam, The Netherlands.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Head
authors.forename: Jochen
authors.initials: J
authors.lastname: Börgermann
authors.forename: Ruben L J
authors.initials: RL
authors.lastname: Osnabrugge
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Kieser
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: David P
authors.initials: DP
authors.lastname: Taggart
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.forename: Jan F
authors.initials: JF
authors.lastname: Gummert
authors.forename: Arie Pieter
authors.initials: AP
authors.lastname: Kappetein
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods / Q000639:trends*; D003324:Coronary Artery Disease / Q000517:prevention & control / Q000601:surgery*; D003657:Decision Making; D005544:Forecasting; D006085:Graft Survival; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000639:trends; D020858:Tissue and Organ Harvesting / Q000379:methods / Q000639:trends; D016896:Treatment Outcome
keywords: Anaortic; Arterial grafting; Coronary artery bypass grafting; Endoscopic vein harvesting; Epiaortic scanning; Graft flow measurement; Guidelines; Heart team; Hybrid revascularization; Minimally invasive; Off-pump; Secondary prevention